Docs Feel Pressure to Give Addicts Opioids

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By Kristina Fiore, Staff Writer, MedPage Today,Published: October 24, 2012

A push to treat chronic pain and financial disincentives for treating addiction may pressure clinicians into prescribing opioids for patients who are already addicted, a researcher suggested.

Over the past decade, there’s been a perfect storm of changing clinician attitudes toward pain treatment and patient attitudes towards suffering, combined with a lack of compensation for time-consuming clinic visits such as addiction counseling, Anna Lembke, MD, of Stanford University, wrote in a perspective in the New England Journal of Medicine.

That may be leading doctors to write scripts for pain pills even if they know those patients are abusing their medications, Lembke wrote.

“Treatment of pain is held up as the holy grail of compassionate medical care,” she wrote, and clinicians have, over the last decade, felt more compelled to deliver treatment.

They also have the additional pressure of consumer ratings sites, because patients who are dissatisfied may turn around and leave a less-than-favorable review online. Lembke cites the example of one colleague who will occasionally bite the bullet: “Sometimes I just have to do the right thing and refuse to prescribe them, even if I know they’re going to go on Yelp and give me a bad rating,” the colleague told her…

Related Resources

• Cochrane reviews for pain management (anesthesia and pain control)
  More info about Cochrane reviews (systematic summaries of medical studies) at http://www.cochrane.org/cochrane-reviews
• MedlinePlus-Pain has links to resources on treatments, alternative therapy, research news, and more

Related articles

• As new MaineCare opioid restrictions take effect, hospital program to help with withdrawal (bangordailynews.com)
• Many injured workers remain on opioids, study finds (jsonline.com)
• Narcotic Abuse (iamaddicted2.wordpress.com)
• Action Alert: Physicians for Responsible Opioid Prescribing (PROP) We must stop this Petition! (rsdadvisory.com)
• Experts to tackle prescription drug issues (news.com.au)
• Legal Barriers to Effective Pain Control (Part One) (lawprofessors.typepad.com)

Skeptical Scalpel: Robots attack America, but Canada not so much

A laparoscopic robotic surgery machine. Patient-side cart of the da Vinci surgical system. Into the sealed Computer God Robot Operating Cabinet, as a Frankenstein slave, at night. Da Vinci Surgical System. (Photo credit: Wikipedia)

Robotic surgery has its place. However, robotic surgery is not superior to traditional surgery in every case or for every surgery candidate.  It is best to discuss the pros and cons (and alternatives)  of any surgical procedure with trusted health care professionals.
Discussion starters below under Related Resources.

Why I am posting this? Partly because a recent article in my local newspaper read more like an advertisement for robotic surgery than an unbiased news item.  It seemed to have been written the surgeon interviewed (or at least had only one source of information — the surgeon who touted robotic devices). Am seriously considering a letter to the editor gently inquiring about their journalistic standards. I know they have a skeletal staff of reporters, and no longer have a staff librarian to do research. Still.

Skeptical Scalpel: Robots attack America, but Canada not so much

As of December 2011, 1548 surgical robots have been sold and installed in the United States as opposed to 16 in Canada.

The estimated population of the U.S is 313,388,000 and for Canada, 34,764, 600.

Canada has a population that is 11.1% of the U.S. population but Canada has only about 1% as many robots. Or put another way, Canada has 1 surgical robot for every 97 robots in the U.S….

..

The estimated population of the U.S is 313,388,000 and for Canada, 34,764, 600.

Canada has a population that is 11.1% of the U.S. population but Canada has only about 1% as many robots. Or put another way, Canada has 1 surgical robot for every 97 robots in the U.S.

California’s population is 37,691,912, which is about 3 million more than the population of Canada, but California, with 114 robots, has seven times as many robots as Canada..

Related Resources (will be adding resources included unbiased items about robotic surgery by the end of the week)

• Explore your treatment options: start the conversation (one of a series of great tips by the US Agency for Healthcare Reseearch and Quality (AHRQ) )
• Questions are the answer – your health care depends on good communication (AHRQ)
  This Web site lets you make a list of questions that you can bring to your medical appointments and gives you tips on talking with your doctor.
• More assistance & helpful tips via AHRQ via the Patient/Consumer site

Related articles (Pros and Cons for informational purposes)

• [Reblog] How hospitals recoup the cost of buying robotic surgery systems (jflahiff.wordpress.com)
• Robotic surgery shouldn’t be universally dismissed (kevinmd.com)
• DistalMotion’s Surgical Tool Combines the Best of Robotic and Endoscopic Surgery (medgadget.com)
• Robot Performs Prostate Surgery (blogs.wsj.com)
• Intuitive Surgical Sued In New York Over Death of 24 Year Old Woman Arising from the Use of the daVinci Robot During a Hysterectomy (ducknetweb.blogspot.com)
• Could pricey surgical robots make their way into medium-sized hospitals? (medcitynews.com)
• Open-source Platform Aids Surgical Robotics Research (it4good.wordpress.com)
• Fewer deaths, complications with robotic bladder cancer surgery, but cost is higher (medicalxpress.com)